1. Physiology of labor. Anesthesia in labor Lecture by assist.prof. BerbetsAndriy

2. LABOR–is the physiology process whereby regular uterine activity causes progressive cervical dilatation and usually results in delivery of the fetus, after 22 weeks of pregnancy

3. Labor is a physiologic process that permits a series of extensive physiologic changes in the mother to allow for the delivery of her fetusthrough the birth canal. It is defined as progressive cervical effacement, dilatation, or both,-resulting from regular uterine contractions that occur at least every 5 minutes and last 30-60 seconds.

4. Classification of labor PRETERM LABOR– delivery the fetusfrom the cavity of uterus in 22-36 weeks of pregnancy. TERM LABOR- delivery the fetusfrom the cavity of uterus in 37-42 weeks of pregnancy. Delayed labor- delivery the fetusfrom the cavity of uterus after 42 weeks of pregnancy.

5. Theories, which explain the mechanism of birth beginning Mechanical Immune Placenta Chemical Endocrine Modern

6. Forerunners of labor The bottom of uterus is lowering Insertion of pre-lying part Krestellers cork is going away. Reductions of woman’s weight. Irregular muscular contractions of uterus. Maturity of uterus’s neck

7. BISHOP’SSCALE 0-2 points – uterus’ cervix is “immature” 3-4 points – cervix is “mature but not enougph” 5-8 points– cervix is “mature”

8. Cervical effacement in nullipara women

9. Cervical dilataton in multipara women

10. Physiological Preliminary period Characteristics: Irregular uterine contractions. There are no structure changes in the cervix of uterus. Duration 6-8 hours

11. Labor begins with Regular muscular contractions. Cervical effacement. Forming fertile vial.

12. Forewaters

13. Labor stages І stage (cervical) – dilatation of the cervix(maximally 15hrs.) ІІ stage (pelvic) – starts from complete dilatation of cervix to the delivery of baby (1-2 hrs.). ІІІ stage(placental)- starts from the birth of baby till delivery of the placenta. (5-20 min.).

14. The first period of labor

15. Uterine contractions –regular contractions of uterine musculature. Typically, contractions occur every 5-10 minutes and last for 20-25 seconds in the onset of labor. As labor pregresses, the contractions become more frequent, more intense, and last longer.

16. Characteristics of uterine contractions Tonus – minimal pressure between contractions – 10-12 mm Hg. Intensivity – difference between amplitude and basal tonus of uterus30-50-70mm Hg. Frequency per 10 min – 3-4 за 10 min. Duration – 35 - 93 sec. Rhythm - intervals between contractions – equal. Activity = intensivityхfrequency per 10 min = 280-340 Montevideo units

17. The second stage of labor

18. Bearing-down efforts (or pushing) Is the periodic contractions of diaphragm, pelvic floor muscles and front abdominal which increase the force of uterine contractions. They are started after complete cervix dilation, when the fetal head descends to the pelvic cavity.

19. The birth canal

20. Record methods of labor Tocography (external and inernal) Radiotelemetry. Electrogisterography. Cardiotocography.

21. Friedman’s curve А – dynamic of cervical effacement Б – descending of presenting part of fetus

22. The partogram

23. Cardiotocography

24. Cardiotocography

25. Fetal blood sampling

26. Types of placenta separation

27. Sign by Shreder

28. Sign by Kustner а) б)

29. Methods of obtainment of the separated placenta (afterbirth) Abuladze. Genter. Krede-Lazarevich.

30. Method by Abuladze

31. Genter’s Method

32. Krede-Lazarevich’s method

33. Examination of placenta and membranes

34. Hand separation of placenta

35. Indications to Anesthesia: No effect from the psychoprophylaxis; Gestoses of the second half of pregnancy Hard extragenitalpatology Operative interferences Labor abnormalities